New Insight for HBV DNA and HBsAg Quantitation during Antiviral Therapy in Patients with Chronic Hepatitis B

Yoo-Kyung Cho; Byung-Cheol Song

doi:10.4166/kjg.2011.57.3.144

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Cho and Song: New Insight for HBV DNA and HBsAg Quantitation during Antiviral Therapy in Patients with Chronic Hepatitis B

Review Article

Korean J Gastroenterol 2011;57(3):144-149.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.3.144

New Insight for HBV DNA and HBsAg Quantitation during Antiviral Therapy in Patients with Chronic Hepatitis B

Yoo-Kyung Cho, Byung-Cheol Song

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea

Correspondence to: Byung-Cheol Song, Department of internal Medicine, Jeju National University School of Medicine, 1, Ara-dong, Jeju 690-716, Korea. Tel: +82-64-717-1060, Fax: +82-64-717-1131, E-mail: drsong@jejunu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Over the past decade, advances in the antiviral therapy in patients with chronic hepatitis B have enabled the sustained suppression of hepatitis B viral replication and the prevention of progressive liver disease. Hepatitis B surface antigen (HBsAg) has been used to diagnose patients with hepatitis B virus infection. Recently, test for quantitative HBsAg titers are available and on-treatment HBsAg quantitations are used to predict treatment outcome. Serum HBV DNA levels have been shown to predict natural course of chronic hepatitis B infection. The HBV DNA levels have been reported to be positively correlated with the development of cirrhosis, hepatocellular carcinoma and related death. The baseline and on-treatment levels of HBV DNA are important factors for predicting treatment outcomes. In this article, we will discuss the role of HBV DNA and HBsAg quantitation during antiviral therapy.

Keywords: Chronic hepatitis B, Hepatitis B virus DNA, Hepatitis B surface antigens

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Table 1.

Relative Risks of Liver Cirrhosis, Hepatocellular Carcinoma and Death Depending on Serum HBV DNA

Serum HBV DNA (copies/mL)	Liver cirrhosis	HCC	HCC-related death	Liver cirrhosis-related death
<300	1.0	1.0	1.0	1.0
300–10⁴	1.4 (0.9–2.2)	1.0 (0.5–2.2)	0.7 (0.3–19)	5.3 (0.7–43.5)
10⁴-10⁵	2.5 (1.6–3.8)	2.7 (1.3–6.6)	2.1 (0.9–5.0)	7.6 (0.9–63.1)
10⁵-10⁶	5.9 (3.9–14.4)	8.9 (4.6–17.6)	6.9 (3.1–15.4)	11.1 (1.3–94.4)
≥10⁶	9.8 (6.7–14.4)	10.7 (5.7–20.1)	5.7 (2.4–13.6)	15.6 (1.8–134.7)

HCC, hepatocellular carcinoma.

95% confidence intervals; 5 copies/mL corresponds to 1 IU/mL.

Table 2.

Effect of Early Viral Suppression (24 Week) on 1 Year Treatment Outcomes in HBeAg-positive Chronic Hepatitis B Patients Treated with Lamivudine or Telbivudine

Serum HBV DNA at 24 week (copies/mL)	Percentage response at 1 year
Serum HBV DNA at 24 week (copies/mL)	HBV DNA PCR-negative	Normalization of ALT (%)	HBeAg loss or seroconversion (%)	Resistance (%)
Not detected (<300 copies/mL)	90–100	90	41–43	0–2
<3 log	62–89	88–89	26–35	0–6
3–4 log	24–80	71–80	10–13	12–19
>4 log	7–54	54–56	4–7	15–26

Table 3.

Predictive Values of SVR ^a Depending on HBsAg Decline at Week 12 and Week 24 Treated with Peginterferon in Patients with HBeAg Negative Chronic Hepatitis B

Week 12				Week 24
HBsAg decline	All patients	SVR ^a (%)		HBsAg decline	All patients	SVR (%)
HBsAg decline	All patients	Yes	No	HBsAg decline	All patients	Yes	No
≥0.5 log IU/mL	9	8 (89)	1 (11)	≥1 log IU/mL	12	11 (92)	1 (9)
＜0.5 log IU/mL	39	4 (1)	35 (90)	＜1 log IU/mL	36	1 (3)	35 (97)

^a SVR: sustained virological response defined as undetectable serum HBV DNA (<70 copies/mL) 24 weeks after treatment.

Table 4.

Predictive Values of SVR ^a Depending on HBsAg Decline at Week 12 and Week 24 Treated wih Peginterferon in Patients with HBeAg-positive Chronic Hepatitis B

Week 12				Week 24
HBsAg decline	All patients	SVR ^a (%)		HBsAg decline	All patients	SVR (%)
HBsAg decline	All patients	Yes	No	HBsAg decline	All patients	Yes	No
Any decline ^b				Any decline
Yes	139	35 (25)	104 (75)	Yes	158	36 (23)	122 (77)
No	63	2 (3)	61 (97)	No	51	4 (8)	47 (92)

^a SVR: sustained virological response defined as HBeAg loss with HBV DNA ＜10,000 copies/mL at 26 weeks after treatment.

^b Any decline was defined as any decrease in serum HBsAg level from baseline.

Table 5.

HBsAg Loss in Total Population at Year 3 of Telbivudine Therapy according to HBsAg Decline at 24 Week and 1 Year

Week 24			1 year
HBsAg decline	All patients	Patients with HBsAg loss (%)	HBsAg decline	All patients	Patients with HBsAg loss (%)
≥0.5 log IU/mL	53	7 (13)	≥1 log IU/mL	32	8 (25)
0–0.5 log IU/mL	48	2 (4)	0–1 log IU/mL	74	1 (1)
≤0 log IU/mL	61	0 (0)	≤0 log IU/mL	56	0 (0)
p-value		p=0.0024			p<0.0001

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